Provider Demographics
NPI:1245237833
Name:LANDMAN, MICHAEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:LANDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 ETIWANDA AVE
Mailing Address - Street 2:STE 312
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6126
Mailing Address - Country:US
Mailing Address - Phone:818-609-0600
Mailing Address - Fax:
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:STE 312
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6126
Practice Address - Country:US
Practice Address - Phone:818-609-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22817207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A228170Medicaid
CAA22817Medicare ID - Type Unspecified
CAA23252Medicare UPIN